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Climate, Health and Resilience:
A photo voice exploration from the
Indian Sundarbans
Shibaji Bose, Upasona Ghosh, Rittika Brahmachari, Sabyasachi
Mandal, Asha George
3rd Global Symposium for Health System Research
2nd October, 2014
The Sundarbans……
Triple betrayal:
Geography
Climate
History/Politics
4.5 million people
• on 54/106 islands
• Subsistence agriculture and
forest /river products
• Chronic poverty
• Double burden of disease
• Sub-optimal health care
system
2
4
Whose Voices more specifically?
Mothers with children 0-6 years of age, who also are
Crab and fish collectors
Living on embankment
Schedule Tribe
Religiously minority community
(Muslims)
Women headed households
Community with large agricultural land
To explore Voices from the ground on
how….
Climate induced livelihoods effect on health systems
Barriers to accessing existing health system and other resources
Adaptive strategies taken by the communities to be resilient
5
Shifting the research to the community….
1. Establishing rapport with
community through group
meetings and informal interactions
2. Selected group leaders through
community consensus
3. Selecting participants with the
help of the leaders
4. Training on use of camera and
consent forms
5. Piloting, learning and modification
6. Data collection and supportive
visits
7. Fortnightly group meetings
6
Climate induced livelihoods effect on health and health system
To some crab catching is the
only livelihood…very
strenuous, hazardous and
time taking
‘Meen dhara’ (prawn seed
collection) entails standing in
waist high saline water for long
periods causing uterus cancer.
There are lot of example in our
village
Husbands are out migrated.
Mothers have to go to the RMP for
treating the ill child. We are scared
but no options
Barriers in accessing existing health system and other resources
This is the situation of the
road leading towards the
PHC during high tide
The mothers and children has
to precariously cross this
water body on this bamboo
pole. It becomes more
difficult after sunset and if
the mother is carrying a child
in her arms
The women have to regularly
cross this water logged
portion to access potable
water.
Adaptive strategies taken by the communities to be
resilient: positive and not so positive
9
I leave my younger child with
the elder one. I know it is very
risky but we do not have option
It is common to take help
of traditional healing
techniques for common
ailments like fever.
We plant mangrove to give
a support to the
embankments
Expressing and raising Voices….
1. Brainstorming with
participants to select
pictures and
narratives
2. Initial meets with
local panchayet, civil
society
representatives and
grass root health
workers
Challenges, limitation and ethical issues
1. Geographical hurdles and monsoons extend the time of
photo voice process.
2. Photo voice in one site stopped due to sudden
inundation
3. Political bias affect photovoice to some extent in one
site
4. Most of the respondents were illiterate. They had to
depend upon the researchers to read out the consent
form.